INTRODUCTION Traditionally, plastic surgery training occurs through the independent model after completion of another surgical residency. Training is a minimum of 3 years in duration. Integrated training in contrast commences upon completion of medical school and is a minimum of 6 years. Independent programs have increasingly been converting positions to integrated positions. Our survey was designed to evaluate possible plans for further conversion of independent positions to integrated positions. METHODS An electronic survey was prepared using the online survey platform Qualtrics. The survey questions were designed to solicit information regarding plans to convert independent positions to integrated positions. The survey was distributed by e-mail to program directors of the independent programs participating in the 2019 match. A reminder was sent 3.5 weeks after initial distribution, and results were collected for an additional 3 weeks. RESULTS Sixteen program directors responded to our survey including 15 complete responses and 1 partial response representing a 40% response rate. Four respondents reported that they are considering decreasing their independent program by 1 position and converting the position to an integrated position. Three respondents reported that they are considering eliminating their independent program and converting to an integrated program. Each of these programs reported their independent program as having 1 position per year. With only a 40% response rate, 7 or more positions may be converted to integrated positions in the coming years. CONCLUSIONS Independent programs have been converting some or all positions to integrated positions. Although most plastic surgery positions were previously through the independent model, in 2019, 172 positions were offered through the integrated match compared with 63 for the independent match. Results of our study indicate that independent positions will continue to be converted to integrated positions for the next few years.BACKGROUND Application of collagen products to wounds has been shown to improve wound healing. Using a collagen-based hydrogel (cHG) capable of cellular support previously developed by our laboratory, we hypothesize that our hydrogel will increase the speed of wound healing by providing a 3-dimensional framework for cellular support, increasing angiogenesis and cell-proliferation at the wound bed. METHODS Two, 10-mm excisional wounds were created over the dorsum of 12 male, genetically modified Zucker diabetic rats. Wounds were splinted open to limit healing by wound contracture. One wound was treated with an occlusive dressing (OD), whereas the adjacent wound was treated with an OD plus cHG. Occlusive dressings were changed every other day. Hydrogel was applied on day 2 and every 4 days after until complete wound closure. Rate of wound closure was monitored with digital photography every other day. Wounds were harvested at days 10 and 16 for histological and immunohistochemical analysis. RESULTS Wound closurnsive feature of collagen hydrogel and its structural stability at body temperature demonstrate promising clinical potential as a vehicle for the delivery of therapeutic cells to the wound bed.BACKGROUND For soft-tissue defect coverage in the lower leg and around the knee joint, the gastrocnemius muscle flap is the most commonly used. Having constant anatomy, a long pedicle, and decreased donor site morbidity, the medial sural artery perforator (MSAP) flap may represent a good reconstructive alternative. The aim of this report was to present the experience of using a dual perforator MSAP pedicled flap. METHODS Nineteen patients underwent soft-tissue reconstruction by MSAP flap in the one third of the lower leg and around the knee joint. Eleven patients were injured in traffic accidents. Exposure of a knee prosthesis required flap coverage in 4 cases. The other defect etiologies were a gunshot wound, bone abscess due to a sickle cell anemia, bone exposure due to a full thickness burn, and sarcoma resection. Defect dimensions ranged from 7 × 5 cm to 15 × 8 cm. Seventeen flaps were harvested with 2 perforators. Donor sites were closed primary in 16 of the 19 cases. RESULTS The sizes of the MSAP flaps ranged from 7 to 22 cm × 5 to 8 cm. The procedure was uneventful in 17 cases. The 2 unsuccessful flaps developed a distal necrosis, for which an excision with direct suture was made secondary. Complete healing was achieved in all cases. CONCLUSIONS The pedicled MSAP flap represents a versatile option in soft-tissue defect coverage of the lower leg and around the knee joint. Inclusion of 2 perforators could render the flap safer and increase its skin paddle, making it suitable for larger defects.PURPOSE The purpose of this study was to analyze the rates of burnout and contributory factors among US plastic surgery residents. https://www.selleckchem.com/products/way-309236-a.html METHODS The Maslach Burnout Inventory Human Services Survey was emailed to program coordinators of American College of Graduate Medical Education-accredited plastic surgery residencies. Scores are provided for 3 subscales emotional exhaustion (EE), depersonalization (DP), and personal accomplishment. Normative scoring tables (low, average, high) were used for comparison. Residents were asked questions relating to their personal life (age, postgraduate year, marital status, and program characteristics). RESULTS One hundred thirteen residents responded. The average age was 31.6 years (range, 25-43 years) and postgraduate year of 4.6 (range, 1-10). There were equal male and female respondents. Most were from integrated-only residencies (n = 59, 52.2%). On average, the majority reported working 50 to 80 hours per week (n = 93, 82.3%), spending the majority of time in tertiary referral centers (n = 107, 94.7%). Most received and took 3 weeks of vacation per year (n = 68, 60.7%). Furthermore, 65.5% met the definition of burnout by their scores from at least 1 subscale.The number of hours worked per week significantly correlated with increased scores in the EE and DP subscales. Residents who worked more than 80 hours per week had significantly higher scores in the EE and DP categories. Residents who had less than 2 weeks of vacation per year trended toward experiencing more EE (EE; 46.0, P = 0.077). The type of program (independent vs integrated), sex, having a significant other outside of the home, kids, and local family support did not significantly affect burnout scores for any subscales. CONCLUSIONS Burnout exists among plastic surgery residents especially in the DP subscale. Working longer hours and less vacation correlates with increased rates of burnout among residents.